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Home My WebLink AboutPermit Building 1982-11-17 Owner f::-I JrsT AddressAO/ ~ Job Address /600 CG/l}IE3'/iJA//lfl- '~I.'J//J \~ 0-3 QS~ I . (~4{)z., //J/TP'/1.9T/frE AAA/k aPO/tE: .~ I ~ I jJ~~ ;l~o.?.:21 rr '5 Range __~ S (j,S?'1 71 INFORt1ATION liNt. 726-3753 ., Sq. Ftq. r.1a i n cJ::: ~q. Ftg. Access. )V Sq. Ftq. Other Ne\1 Add Alter P.ep. . ~ --Fence Demo Change/Use -+- --Other-- -- -0 . INSPECTION LINE. 726- 37 69 . CITY OF SPR NGFIELD( COt1BINATION APPLICATION/PERMIT /// ENERGY SciURCES: Heat l1ater Heater . Legal Description va11 0;:00/ 7~ Bui1dinq Permit Info: Describe Work(i,e., Family ((esidence 11ith ftttached Garaoe) - Build Single Address DES I GN TEAt1 (name) Phone (address) A e/tOOr /W/f/J/ lfoOF tV IT/-! ~lL/f5A/c;-COAk'/J1/6 42() 1A).A1 G?A- ~ 7 /J- A'I)O r (lies. no.)' (expires) . (phone no.) Construction Lender Primary . Structura 1 Electrical Mechanical - CONTRACTORS (name) - General At3E )(017;:::-//1/1>- /JlJC (address) (1 ics. no.) $/9'/,}~ (exoires) . /j t,/s>'3 (ohrme no. ) ;2 $'07 -t C//{JC//V AP ~VG-~/V~ '"z;. 44 D 26 <7 . PI umbi nq . El ectri ca 1 ~lechanica 1 PLUt.1B f NG ELECTRICAL , FEE 'CHARGE NO.' I FEE I rl:lARGE.1 NO. I Res i dence of furnace/burner to SQ. FT. BTU' s MECHANICAL NO.1 Each single fixture I FF I' I rl:iARGL d Relocated building (new fix. additional) New circuits alts. or extensions . Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Soace heater and vent Of I I I I App Ii ance vent seoarate I Stationary evap. cooler I Vent fan wi th sinole duct I Vent. system apart from I heatinq or A.C. I Mechanical exhaust hood and duct I \1ood stove/heater I I I Sewer ITempOrary Construction IChange in existing residence . I multifamily, comm. or Industrial ~Jater servi ce Storm Sewer amps.1 COMM./IND. FEEDERS I Install/alter/relocate I distrih. feeders 10f I I I amps.1 I ISSUANCE OF PFRMIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES \1HERE STATE L,'\W REQUIRES that tile Electrical work be done by an Electi'ical Contractor, the. electrical portion of this permit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAt1INED the completed application for permit, and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed.shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon oertaining to.the work described herein, and that NO OCCUPAr~CY will be made -of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.D55 will be used on this project. Zone Fire Zone Flood Plain Type/Const. Bedrooms Stories Units Occy Load Occy Group SIGNAT~..d""~..// ~ FOR OFFICE USE 6r~L Y IV So. Ftc]. t1ain Sq. Ftc]. Access Sq. Ftg. Other DATE I; f7/.$-"..2~ ,.' I NAME(please print) ~/~~~t:~ /fOE x Val u.e Value Value x x BU I LD I NG PER~1IT __~~.a') , Plan Ck. Comm/Ind Charges .and 65%/Blda Per Fee Surcharges ' . (00 Plan Ck. Res 30%/Bldq Per Fee PLUt~BING PERMIT Fence Charges and ------------ I Dt;mo 1< Surcharges ELECTRICAL PERMIT Sidewalk I Cha rges and ------------ I Surcharges A/C Pavfng MECHANICAL PERMIT I Curb Cut I Charges and -------._---- Surcharges I I TOTAL VALUATION ~ .syste.ms Development. - . . .~ fharqe (1.5%) . .~ Total Comb. Permit TOTAL 1/.00 .J _ _l... ...., ..,.,. . i...IOI;a. I .", . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VA~IDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air qas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check-new ~ if addition, check add, etc. > F, Building permit information: 1. example - construct single family house with an a ttached garage 2. example - remodel existing garage into"family room 3, example - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedul es C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D; As noted on.the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor, The general contractor is not authorized to sign the electrical label. --- III. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his signature. . IV. Fees and Charges Plan check fees are due and payable at the time of the application, and no plans will be processed until these fees are paid. All other fees and charges are due and. payable when the permit is issued. V. FOR OFFICE USE ONLY Permit Clerk ~rL- ~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name . .", signature date .